Soaking the affected areas of skin in lukewarm water may provide some temporary relief. Dabbing the affected areas with baking soda or apple cider vinegar may help , or applying coconut oil after a bath. Patients with cholestasis will have low levels of vitamin K, increasing the chance of hemorrhage, so a mother will often need Vitamin K supplements before and after delivery.
According to the American Pregnancy Association, natural remedies for liver health include and dandelion root and milk thistle, and calamine lotion may help with itching, but any supplements or alternative treatments should be discussed first with a physician, as the effects during pregnancy may be unknown. Some sources recommend oatmeal baths, but the American Pregnancy Association says the use of Aveeno or oatmeal baths should be avoided. They also warn against the use of antihistamines. Many women choose to take herbs, creams, baths, and tinctures instead of medication.
Some herbs are difficult to break down, especially when the liver is already compromised. It is very important to check with the doctor beforehand, to make sure a natural remedy is safe, and to consult the doctor if symptoms get worse.
The mother will also be asked about her personal and family medical histories, and there will be a physical examination. Blood levels of bile will also be measured. To reduce the risk of cholestasis and other problems during pregnancy, it is important to follow a healthful, balanced diet with plenty of fresh fruit and vegetables. Organic produce is less likely to be affected by pesticides and other toxins.
If canned produce is used, check that it is preserved in its own juice and that there are no added sugars. Choose certified organic meat and avoid fried fish and raw seafood. Dried beans and legumes, such as lentils and chickpeas, are a good source of protein. You should drink 8 to 12 glasses of water a day, and avoid alcoholic drinks and sodas, such as cola. Drinking alcohol will not cause cholestasis in pregnancy, but alcohol should be avoided during pregnancy, as it can lead to a number of complications, including other types of liver disease.
Diet is not an alternative to medication that is prescribed by the physician. It should be percent organic. Bile is a yellow-green fluid that helps to digest fat. It mainly consists of cholesterol , bile salts, and the pigment bilirubin. It is produced by the liver and stored in the gallbladder. From the gallbladder, it passes through the common bile duct, into the duodenum. Some studies have found that babies whose mothers have ICP have a higher chance of being born prematurely or stillborn.
Because of the link with stillbirth, you may be offered induction of labour. This could be any time from 35 weeks, depending on the level of bile acids in your blood. If you have ICP, you will probably be advised to give birth in hospital under a consultant-led maternity team. ICP is diagnosed by excluding other causes of the itch. Your doctor will probably talk to you about your medical and family history and order a variety of blood tests.
If you are diagnosed with ICP, you will have regular liver function tests so your doctor can monitor your condition. These readings help doctors recommend when your baby should be born. If your LFTs and bile acids are normal and you continue to have severe itching, the blood tests should be repeated every week or 2, to keep an eye on them.
Creams, such as aqueous cream with menthol, are safe to use in pregnancy and can provide some relief from itching. There are some medicines, such as ursodeoxycholic acid UDCA , that help reduce bile acids and ease itching. UDCA is considered safe to take in pregnancy, although it is prescribed on what is known as an "informed consent" basis as it has not been properly tested in pregnancy. You may also be offered a vitamin K supplement.
This is because ICP can affect your absorption of vitamin K, which is important for healthy blood clotting. Most experts on ICP only prescribe vitamin K if the mother-to-be reports pale stools, has a known blood clotting problem, or has very severe ICP from early in pregnancy.
The incidence of ICP also shows a striking geographical pattern, with a higher prevalence in Scandinavia and South America specifically Chile where the reported prevalence is as high as Mothers and sisters of patients are also at higher risk of developing the condition, proving that there is a definite genetic predisposition.
ICP poses several risks that are of great concern. It is associated with an increased risk of stillbirth intrauterine fetal demise , premature labor, respiratory distress in the neonate, meconium staining, preeclampsia and gestational diabetes.
The elevated bile acids are thought to interfere with the formation of a chemical called surfactant which allows the lungs to expand after birth. There is an increased risk of an infant needing respiratory support after birth. Sometimes often in response to fetal distress it is expelled into the amniotic fluid prior to birth, or during labor. If the baby then inhales the contaminated fluid, respiratory problems may occur.
In pregnancies affected by cholestasis, meconium is often passed prior to birth. ICP has been associated with a substantial rate of preterm birth. Earlier presentations of Intrahepatic Cholestasis of Pregnancy ICP seem to carry an even greater risk of preterm labor, as well as twin or triplet pregnancies.
Stillbirth tends to occur in the last few weeks of pregnancy. The reason this occurs is not completely understood although it is thought to be due to a cardiac arrhythmia caused by the elevated bile acids. A recent meta-analysis was able to further clarify the risk of stillbirth in a pregnancy complicated by cholestasis and showed that this risk increases as bile acids become more elevated.
There is still much to be learned about the exact causes of ICP and its manifestation, but researchers are currently investigating genetic, hormonal and environmental factors. The causes are likely to be due to a number of different factors, including:. Genetic predisposition — Research thus far has identified several gene mutations involved. ICP has been shown to extend in families. Mothers and sisters are at higher risk of developing the condition, proving that there is a definite genetic predisposition although additional research is needed to explain all cases of the condition in reference to genes.
The flow of bile acids is significantly reduced and leads to the bile acids building up in the blood that causes the symptoms. Note: Women carrying multiples, women who have had IVF treatment and women who have prior liver conditions also appear to have a higher risk of cholestasis.
Although the reason for this is not clear, it suggests that there is an environmental trigger for the condition, such as a reduced exposure to sunlight or a change in diet. Despite the possible outcomes of ICP, proper treatment provides a great degree of reduction in both fetal risk and maternal symptoms. The two main treatments are with a medication called ursodeoxycholic acid and proper delivery timing. UDCA is a naturally occurring bile acid that improves liver function and may help reduce total bile acid concentration in the bloodstream.
A recent trial was unable to show an improvement in a composite clinical outcome with the use of this medication but it may still have some benefit in some cases and is still recommended.
0コメント